Provider Demographics
NPI:1013904911
Name:LEGOME, MILTON E (MD)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:E
Last Name:LEGOME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 W STEWART DR
Mailing Address - Street 2:SUITE 510
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3854
Mailing Address - Country:US
Mailing Address - Phone:714-538-8549
Mailing Address - Fax:714-538-1547
Practice Address - Street 1:1310 W STEWART DR
Practice Address - Street 2:SUITE 510
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3854
Practice Address - Country:US
Practice Address - Phone:714-538-8549
Practice Address - Fax:714-538-1547
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2023-06-01
Deactivation Date:2023-04-12
Deactivation Code:
Reactivation Date:2023-06-01
Provider Licenses
StateLicense IDTaxonomies
CAC23153174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C231530Medicaid
CA00C231530Medicaid
CAA32320Medicare UPIN